What are the 5 locations where UTIs are most common?
1. Kidney (Pyelonephritis)
2. Ureter (Ureteritis)
3. Bladder (Cystitis)
4. Prostate (Prostatitis)
5. Urethra (Urethritis)
Which UTIs are located in the lower UT?
Which UTIs are located in the upper UT?
What pathogen(s) are the most likely causative agent(s) for uncomplicated UTIs?
What pathogen(s) are the most likely causative agent(s) for complicated UTIs?
and many others!
What is the clinical presentation for lower UTIs (cystitis)?
Urinary urgency and frequency
hemorrhagic cystitis (10% of cases)
What is the clinical presentation for lower UTIs (prostatitis)?
pain and tenderness in lower back and suprapubic area
perirectal area and testicles
more severe symptoms
bacteremia and hematuria
What is the clinical presentation for upper UTIs (pyelonephritis)?
cystitis symptoms (Dysuria, Urinary urgency and frequency, bladder fullness, hemorrhagic cystitis (10% of cases))
What are th pathogenic mechanisms for UTIs?
entry by ascent from urethra
often caused by poor hygiene
adherence to host epithelium - adhesins, pili, and polysaccharides
What E. coli virulence factors contribute to UTIs?
P-pili associated with pyelonephritis (PAP) - mediate binding to uroepithelial cells via glycosphingolipids, and also binds to RBC leading to hemagglutination; inhibits phagocytosis, mannose insensitive, induces interleukin and PMN infiltration to bladder
Type 1 pili - agglutinates RBC and mediates binding, mannose sensitive, genetic switch
Type S fimbriae (SfaI, SfaII) - agglutinates RBCs, mannose insensitive, causes both cystitis AND pyelonephritis, binds sialic acids on glycoproteins, assoc. with neonatal meningitis and bacteremia
afimbrial adhesins (AfaD, AfaE) - adhesion to uroepithelium and internalization
toxins - hemolysin, needs iron for growth; cytotoxin necrotizing factor type I - apoptosis of uroepithelium